Government Policy Permits Taking Advantage Of Elderly

ANOTHER VIEWPOINT

January 24, 1996|By FREDERICK A. GOLDSTEIN

Eldernapping is perfectly legal in most of the United States, highly profitable and very wrong. Each year, thousands of unsuspecting elderly Americans are snatched in the middle of the night against their will and without the knowledge or consent of their relatives.

There is a lot of money to be made from committing seniors to psychiatric facilities, whether they need it or not.

It is a very profitable fraud on the Medicare system by clever health care professionals who line their own pockets by ripping off taxpayers and abusing often defenseless seniors.

As far-fetched as it might sound, a typical scenario might develop something like this: An elderly nursing home resident who is having a "bad day" (the kind that all of us have) raises his cane at a nurse, tells her she is "no damn good" and insists he is going to "get out of this rotten place."After the nurse reports the incident to her supervisor - stressing that the frail, 80-year-old man threatened her with bodily harm - the professional staff recommends that the patient be given a psychiatric examination.

If you think such a course of events is extreme or impossible, think again. Every day in this country, for actions even more trivial than shaking a cane at a nurse and complaining about inadequate care, older Americans are subjected to full-scale psychiatric evaluation, committal and treatment.

By state law, once the nursing home contacts a psychiatric facility, an evaluation of the patient is set in motion. In addition, if the patient meets the criteria for an involuntary examination (and it is pretty easy to see to it that he does, if one wants to) state law requires that he be taken to the nearest psychiatric facility.

You already may be able to guess that the facility may bear a striking resemblance to the one that was first called upon to do do the preliminary evaluation, and that it obviously has a vested interest in recommending that the person be committed.

If all of this sounds unbelievable, it isn't. This practice can be better understood (not excused) in the light of the increasing financial pressures on providers of mental health services and the following circumstances:

-- The number of beds in public psychiatric facilities has decreased, while those in private hospitals has increased.

-- Even private psychiatric hospitals have too many beds and not enough patients to pay for them.

-- Little by little, insurance companies have been scaling back on what services they will pay for.

-- Medicare will pay the full tab for psychiatric treatment of the elderly along with many other individuals.

Should there be any doubt about who is going to be targeted for psychiatric services?

Obviously, there are elderly people who need psychiatric help, and there are others who don't. Those who need it should get it, but those who don't need it should not be snatched and held for ransom at taxpayers' expense.

As long as the financial reward for committing the elderly is as great as it is, private citizens who stand to gain monetarily should no longer be able to exercise an unbridled power to incarcerate often defenseless senior citizens.

First, no one should be involuntarily subjected to a psychiatric evaluation unless by court order after a hearing or by a law enforcement officer. In both instances, the danger that the individual poses to himself or others, if any, must be clear, supported by testimony, immediate, and not speculative.

Second, a person allegedly in need of an evaluation should be taken to an accredited public facility that only does evaluations, with staff on salary. If there is a need to hold a person past the initial evaluation period, then, after a hearing, the person should be able to go to a hospital of his or her choice or to the nearest available hospital from a rotating list.

Third, federal and state governments should stop paying for empty beds. They should impose sanctions on adult living facilities (ALFs) and nursing homes that market their facilities to attract Alzheimer patients but then ship them out to psychiatric hospitals at the first problem. They know full well that while the patient is away, their facility will continue to be paid as though the patient were still in their care.

An ALF, nursing home or other facility that clearly has high numbers of psychiatric admissions should be placed in a special category which decreases their room rates, and they should be required to have a higher staff-patient ratio with better trained professionals so they can treat more patients on site.

Take the guaranteed ransom out of eldernapping and some meaningful changes might occur. At least, the epidemic of body snatching might diminish or come to an end.

The author is an attorney in practice in Fort Lauderdale and an expert in mental health law. He wrote this article for the Sun-Sentinel.